Abstract
Neuroleptic malignant syndrome (NMS) and malignant hyperthermia (MH) may have a common pathogenic mechanism; therefore, it has been suggested that known triggering agents for MH (such as succinylcholine) should be avoided in patients with NMS. Electroconvulsive therapy (ECT) continues to play a major therapeutic role in contemporary psychiatry, and succinylcholine has been the muscle relaxant of choice in attenuating violent muscle contractions induced by ECT. Mivacurium is a nondepolarizing muscle relaxant with a relatively rapid onset and a short duration of action, and to date it has been proved safe in MH- susceptible patients. In this case report, following succinylcholine use during ECT, a patient with NMS developed an increase in temperature and serum creatine kinase (CK) level, possibly due to an MH reaction. Since the patient’s mental status necessitated further ECT, mivacurium was administered during subsequent treatments and resulted in effective attenuation of muscle contractions without elevation of patient temperature or CK levels. In addition, there was no marked prolongation of the anaesthetic. Mivacurium is a suitable agent for patients with NMS undergoing ECT, as it has not been associated with precipitation of an MH response.
Résumé
Le syndrome malin des neuroleptiques (SMN) et l’hyperthermie maligne (HM) semblent avoir une mécanisme pathogène commun; c’est pourquoi on a suggéré d’éviter dans le SMN les agents qui déclenchent l’HM (ex., la succinylcholine). L’électroconvulsivothérapie (ECT) continue de jouer un rôle majeur en pyschiatrie et la succinylcholine est présentement le myorelaxant de choix pour atténuer les violentes contractions musculaires induites par l’ECT. Le mivacurium est un myorelaxant non dépolarisant dont le début d’action est relativement rapide et la durée d’action courte, et jusqu’ à maintenant, on a jugé qu’il ne présentait aucun danger pour les patients susceptibles à l’HM. Dans le cas présent, à la suite de l’administration de succinylcholine pour un ECT, un patient porteur du SMN a présenté une élévation de température et de la concentration de la créatine kinase sérique (CK), peutêtre par réaction d’HM. Comme son état nécessitait des traitements additionels d’ECT, le mivacurium a été administré au cours des traitements ultérieurs et a atténué les contractions musculaires sans élévation de température ou des concentrations de CK. Il n’a pas eu non plus de prolongation appréciable de l’anesthésie. Le mivacurium est un agent approprié pour le SMN et il n’est pas associé au déclenchement de l’HM.
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Kelly, D., Brull, S.J. Neuroleptic malignant syndrome and mivacurium: a safe alternative to succinylcholine?. Can J Anaesth 41, 845–849 (1994). https://doi.org/10.1007/BF03011591
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DOI: https://doi.org/10.1007/BF03011591